SECOND NATURE WILDERNESS PROGRAM NPI 1619191095

NPI Information

SECOND NATURE WILDERNESS PROGRAM is a residential treatment facility emotionally disturbed children in Duchesne, UT. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. SECOND NATURE WILDERNESS PROGRAM NPI is 1619191095. The provider is registered as an organization entity type.
The provider Other Name Is Second Nature Uintas.

The provider's business location address is:

382 WEST MAIN STREET
DUCHESNE, UT
ZIP 84021-318
Phone: (435) 738-2040
Fax: (435) 738-2046

The provider's authorized official is Angie Evans .
The authorized official title is Business Office and has the following contact phone number (801) 766-6604.

The CLIA number assigned to this NPI record is 46D2188473 - other - wilderness program with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/13/2007 and was last updated on 5/29/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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